Provider Demographics
NPI:1134808371
Name:NOWICKI, KELLY (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NOWICKI
Suffix:
Gender:
Credentials:RN
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:NOWICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 631607
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1607
Mailing Address - Country:US
Mailing Address - Phone:713-300-1123
Mailing Address - Fax:
Practice Address - Street 1:2500 FONDREN RD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2313
Practice Address - Country:US
Practice Address - Phone:713-730-2229
Practice Address - Fax:713-334-5547
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1141978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program